椎管减压Dynesys动态固定治疗多节段腰椎管狭窄症的中期临床疗效

Midterm clinical effects of decompression and Dynesys dynamic stabilization in treating multi-segmental lumbar spinal stenosis

中文关键词:  腰椎管狭窄症  多节段  动态固定  疗效  并发症

英文关键词:Lumbar spinal stenosis  Multiple segments  Dynamic stabilization  Efficacy  Complications

中文摘要:

  【摘要】 目的：评估椎管减压Dynesys动态固定治疗多节段腰椎管狭窄症的中期临床疗效。方法：回顾性分析2010年3月～2015年6月在我院接受椎管减压以及3节段以上Dynesys动态固定手术治疗的59例腰椎管狭窄症患者的临床资料，其中男性28例，女性31例，年龄67.6±8.9岁（49～80岁）。统计患者手术时间、失血量、手术并发症情况；术前、术后3个月及末次随访时进行疼痛视觉模拟量表（visual analog scale，VAS）评分评价腰腿痛情况，采用Oswestry功能障碍指数（Oswestry disability index，ODI）评价腰椎功能情况，同时行腰椎X线检查并评估腰椎前凸角、固定节段活动度及上端邻近节段活动度，计算固定节段活动度保留百分比。结果：3节段Dynesys动态固定44例，4节段13例，5节段2例。手术时间259±58min，失血量593±296mL，随访7.2±1.3年（5~9年）。患者术后3个月VAS腰腿痛评分以及ODI明显下降，与术前相比差异具有统计学意义（P＜0.05）。末次随访时，4例患者出现螺钉（6枚）松动，但无腰痛症状；1例患者术后34个月发生深部感染，经穿刺排脓、灌洗以及静脉使用抗生素4周后治愈；无翻修手术病例。末次随访时，固定节段活动度为13.1°±4.7°，较术前（28.9°±8.1°）平均保留了43.8%的活动度；上端邻近节段活动度及腰椎前凸角与术前相比差异无统计学意义（P＞0.05）。结论：椎管减压Dynesys动态固定治疗多节段腰椎管狭窄症是一种安全、有效的方法，且创伤较小，术后腰椎活动功能较好。

英文摘要:

  【Abstract】 Objectives: To assess the midterm clinical outcomes after decompression and dynamic stabilization(Dynesys system) in multi-segmental lumbar spinal stenosis. Methods: The clinical data of 59 patients with lumbar spinal stenosis treated with decompression and 3 or more segments dynamic stabilization in our hospital from March 2010 to June 2015 were retrospectively reviewed. There were 28 males and 31 females, with an average age of 67.6±8.9 years(49-80 years). The operative time, blood loss and complications of the patients were collected. Before operation, at 3 months after surgery and final follow-up, visual analog scale(VAS) was used to assess the pain status of low back and leg, and Oswestry disability index(ODI) was adopted for functional evaluation, and also lumbar lordosis, range of motions(ROMs) of fixed segments and the first upper adjacent segment were evaluated with X-ray examination in the mean time, and the retention of ROM of the fixed segments was also calculated. Results: 3 segmental Dynesys dynamic stabilizations were performed in 44 patients, 4 segmental dynamic stabilizations were in 13 patients, 5 segmental stabilizations were in 2 patients. The operative time was 259±58min, and the average blood loss was 593±296mL. The mean follow-up period was 7.2±1.3 years(range 5-9 years). The VAS scores and ODI at 3 months after operation improved significantly compared with those preoperatively(P<0.05). At final follow-up, loosening was observed in 6 screws in 4 patients, who were asymptomatic; Wound infection developed in 1 patient at 34 months after surgery, which was cured by puncture pumping pus, irrigation and antibiotics for 4 weeks; None of the patients underwent revision surgery. At final follow-up, the ROM of the fixed segments was 13.1°±4.7°, which on average retained 43.8% of the preoperative ROM(28.9°±8.1°), and the ROM of the adjacent upper segement, and lumbar lordosis were preserved compared with before operation with no statistical difference(P>0.05). Conclusions: Decompression and dynamic stabilization with Dynesys system was a safe and effective treatment in patients with multi-segmental lumbar spinal stenosis, which preserves lumbar activities with minor injury.